The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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The Effect of Preoperative Dexamethasone Administration, according to Age and Gender on Postoperative Pain in Patients who Undergo Laparoscopic Choelecystectomy

복강경 담낭절제술에서 연령과 성별이 고려될 때 수술 전 Dexamethasone의 투여가 수술 후 통증에 미치는 영향

  • Lee, Cheol (Department of Anesthesiology and Pain Medicine, School of Medicine, Wonkwang University) ;
  • Kim, Tai-Yo (Department of Anesthesiology and Pain Medicine, School of Medicine, Wonkwang University)
  • 이철 (원광대학교 의과대학 마취통증의학교실) ;
  • 김태요 (원광대학교 의과대학 마취통증의학교실)
  • Published : 2008.06.01
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Abstract

Background: Preoperative dexamethasone improves the surgical outcome after laparoscopic cholecystectomy(LC). The purpose of this study was to determine the effect of preoperative dexamethasone on the postoperativepain according to age and gender in patients who undergo LC.Methods: In this double blind prospective study, 400 patients, males or females :< 45 yr and males or femaless 65 yr (n = 50 in each of eight groups) who undergoing LC were randomized to receive dexamethasone 8mg (5 ml) or saline 5 ml intravenously 100 minutes before their operation, Postoperative pain was assessedon a visual analog scale (VAS) at 1, 6, 12, and 24 hour, and the time to administering the first postoperativeanalgesics was recorded.Results: Dexamethasone was administered without consideration for age and gender, and it reduced thepostoperative pain VAS score at 1, 6, and 12 hours, and the opioid analgesic requirement, but there was nosignificant difference between administering saline or dexamethasone in the same gender and age groups.Females U 45 yr who were administered saline had the most pain sensitivity and males S 65 yr who wereadministered dexamethasone had the least pain sensitivity.Conclusions: Preoperative dexamethasone reduces the pain intensity and opioid consumption, but does notreduce the pain intensity, according to age and gender in the patients undergoing LC. As a result, Preoperativedexamethasone should be considered for routine use for patients who are undergoing laparoscopic cho-lecystectomy. (Korean J Pain 2008; 21: 51 56)

Keywords

References

  1. Alexander JI: Pain after laparoscopy. Br J Anaesth 1997; 79: 369-78 https://doi.org/10.1093/bja/79.3.369
  2. Bisgaard T, Kehlet H, Rosenberg J: Pain and convalescence after laparoscopic cholecystectomy. Eur J Surg 2001; 167: 84-96 https://doi.org/10.1080/110241501750070510
  3. Bisgaard T, Klarskov B, Rosenberg J, Kehlet H: Factors determining convalescence after uncomplicated laparoscopic cholecystectomy. Arch Surg 2001; 136: 917-21 https://doi.org/10.1001/archsurg.136.8.917
  4. Szarvas S, Chellapuri RS, Harmon DC, Owens J, Murphy D, Shorten GD: A comparison of dexamethasone, ondansetron, and dexamethasone plus ondansetron as prophylactic antiemetic and antipruritic therapy in patients receiving intrathecal morphine for major orthopedic surgery. Anesth Analg 2003; 97: 259-63
  5. Liu K, Hsu CC, Chia YY: The effect of dose of dexamethasone for antiemesis after major gynecological surgery. Anesth Analg 1999; 89: 1316-8 https://doi.org/10.1213/00000539-199911000-00046
  6. Liu K, Hsu CC, Chia YY: Effect of dexamethasone on postoperative emesis and pain. Br J Anaesth 1998; 80: 85-6 https://doi.org/10.1093/bja/80.1.85
  7. Bisgaard T, Klarskov B, Kehlet H, Rosenberg J: Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a randomized double-blind placebo-controlled trial. Ann Surg 2003; 238: 651-60 https://doi.org/10.1097/01.sla.0000094390.82352.cb
  8. Afman CE, Welge JA, Steward DL: Steroids for post-tonsillectomy pain reduction: meta-analysis of randomized controlled trials. Otolaryngol Head Neck Surg 2006; 134: 181-6 https://doi.org/10.1016/j.otohns.2005.11.010
  9. Wang JJ, Ho ST, Liu YH, Lee SC, Liu YC, Liao YC, et al: Dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy. Br J Anaesth 1999; 83: 772-5 https://doi.org/10.1093/bja/83.5.772
  10. Rosseland LA, Stubhaug A: Gender is a confounding factor in pain trials: women report more pain than men after arthroscopic surgery. Pain 2004; 112: 248-53 https://doi.org/10.1016/j.pain.2004.08.028
  11. Ochroch EA, Gottschalk A, Troxel AB, Farrar JT: Women suffer more short and long-term pain than men after major thoracotomy. Clin J Pain 2006; 22: 491-8 https://doi.org/10.1097/01.ajp.0000208246.18251.f2
  12. Gagliese L, Katz J: Age differences in postoperative pain are scale dependent: a comparison of measures of pain intensity and quality in younger and older surgical patients. Pain 2003; 103: 11-20 https://doi.org/10.1016/S0304-3959(02)00327-5
  13. Aubrun F, Salvi N, Coriat P, Riou B: Sex- and age-related differences in morphine requirements for postoperative pain relief. Anesthesiology 2005; 103: 156-60 https://doi.org/10.1097/00000542-200507000-00023
  14. Barnes PJ: Molecular mechanisms and cellular effects of glucocorticosteroids. Immunol Allergy Clin North Am 2005; 25: 451-68 https://doi.org/10.1016/j.iac.2005.05.003
  15. Wang JJ, Ho ST, Tzeng JI, Tang CS: The effect of timing of dexamethasone administration on its efficacy as a prophylactic antiemetic for postoperative nausea and vomiting. Anesth Analg 2000; 91: 136-9 https://doi.org/10.1097/00000539-200007000-00025
  16. Sapolsky RM, Romero LM, Munck AU: How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions. Endocr Rev 2000; 21: 55-89 https://doi.org/10.1210/er.21.1.55
  17. Hargreaves KM, Costello A: Glucocorticoids suppress levels of immunoreactive bradykinin in inflamed tissue as evaluated by microdialysis probes. Clin Pharmacol Ther 1990; 48: 168-78 https://doi.org/10.1038/clpt.1990.132
  18. Hong D, Byers MR, Oswald RJ: Dexamethasone treatment reduces sensory neuropeptides and nerve sprouting reactions in injured teeth. Pain 1993; 55: 171-81 https://doi.org/10.1016/0304-3959(93)90146-G
  19. Holte K, Kehlet H: Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg 2002; 195: 694-712 https://doi.org/10.1016/S1072-7515(02)01491-6
  20. Wen ZH, Wu GJ, Chang YC, Wang JJ, Wong CS: Dexamethasone modulates the development of morphine tolerance and expression of glutamate transporters in rats. Neuroscience 2005; 133: 807-17 https://doi.org/10.1016/j.neuroscience.2005.03.015
  21. Ellermeier W, Westphal W: Gender differences in pain ratings and pupil reactions to painful pressure stimuli. Pain 1995; 61: 435-9 https://doi.org/10.1016/0304-3959(94)00203-Q
  22. Walker JS, Carmody JJ: Experimental pain in healthy human subjects: gender differences in nociception and in response to ibuprofen. Anesth Analg 1998; 86: 1257-62 https://doi.org/10.1097/00000539-199806000-00023
  23. Wise EA, Price DD, Myers CD, Heft MW, Robinson ME: Gender role expectations of pain: relationship to experimental pain perception. Pain 2002; 96: 335-42 https://doi.org/10.1016/S0304-3959(01)00473-0
  24. Robinson ME, Riley JL 3rd, Myers CD, Papas RK, Wise EA, Waxenberg LB, et al: Gender role expectations of pain: relationship to sex differences in pain. J Pain 2001; 2: 251-7 https://doi.org/10.1054/jpai.2001.24551
  25. McEwen BS, Alves SE, Bulloch K, Weiland NG: Clinically relevant basic science studies of gender differences and sex hormone effects. Psychopharmacol Bull 1998; 34: 251-9
  26. Riley JL 3rd, Robinson ME, Wise EA, Price DD: A meta-analytic review of pain perception across the menstrual cycle. Pain 1999; 81: 225-35 https://doi.org/10.1016/S0304-3959(98)00258-9
  27. Von Korff M, Dworkin SF, Le Resche L, Kruger A: An epidemiologic comparison of pain complaints. Pain 1988; 32: 173-83 https://doi.org/10.1016/0304-3959(88)90066-8
  28. Kalkman CJ, Visser K, Moen J, Bonsel GJ, Grobbee DE, Moons KG: Preoperative prediction of severe postoperative pain. Pain 2003; 105: 415-23 https://doi.org/10.1016/S0304-3959(03)00252-5
  29. Thomas T, Robinson C, Champion D, McKell M, Pell M: Prediction and assessment of the severity of post-operative pain and of satisfaction with management. Pain 1998; 75: 177-85 https://doi.org/10.1016/S0304-3959(97)00218-2
  30. Giuffre M, Asci J, Arnstein P, Wilkinson C: Postoperative joint replacement pain: description and opioid requirement. J Post Anesth Nurs 1991; 6: 239-45
  31. Gibson SJ, Farrell M: A review of age differences in the neurophysiology of nociception and the perceptual experience of pain. Clin J Pain 2004; 20: 227-39 https://doi.org/10.1097/00002508-200407000-00004
  32. Wang Y, Mitchell J, Moriyama K, Kim KJ, Sharma M, Xie GX, et al: Age-dependent morphine tolerance development in the rat. Anesth Analg 2005; 100: 1733-9 https://doi.org/10.1213/01.ANE.0000152192.23851.40
  33. Buntin-Mushock C, Phillip L, Moriyama K, Palmer PP: Age-dependent opioid escalation in chronic pain patients. Anesth Analg 2005; 100: 1740-5 https://doi.org/10.1213/01.ANE.0000152191.29311.9B
  34. Corsini E, Battaini F, Lucchi L, Marinovich M, Racchi M, Govoni S, et al: A defective protein kinase C anchoring system underlying age-associated impairment in TNF-alpha production in rat macrophages. J Immunol 1999; 163: 3468-73
  35. Clayton DA, Browning MD: Deficits in the expression of the NR2B subunit in the hippocampus of aged Fisher 344 rats. Neurobiol Aging 2001; 22: 165-8 https://doi.org/10.1016/S0197-4580(00)00196-2